Submission form required for our website

We need a form on our website where visitors can enter their personal details and submit them to us.

We need this information automatically emailed to multiple addresses at the time of submission. One address is a constant for all submissions, the other address(es) will depend on the post code of the sumbmission - so could be as many as over 100 email addresses, and some submissions will need to go to as many as 4 different addresses including the constant one.

We would also like all submissions kept on record somewhere which would be easily accessible and a way of tracking if the emails have been successfully delivered.

The form needs 8 boxes for clients to enter their personal details and a number of other tick boxes from which they can choose as many as they like - but at least one.

If this is possible - we will then need a form placed on at least one of our other sites aswell.